- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $368.58 / $2,902.00 / $7,563.00
| Facility | | $368.58 | $2,902.00 | $7,563.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.02 / $463.92 / $906.03
| Professional | | $271.02 | $463.92 | $906.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,217.00 / $5,196.00 / $11,909.00
| Facility | | $3,217.00 | $5,196.00 | $11,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.18 / $295.67 / $969.93
| Professional | | $226.18 | $295.67 | $969.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $355.21 / $1,254.00 / $4,050.00
| Facility | | $355.21 | $1,254.00 | $4,050.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.21 / $355.21 / $413.93
| Professional | | $355.21 | $355.21 | $413.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.08 / $224.08 / $420.83
| Facility | | $224.08 | $224.08 | $420.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.96 / $443.98 / $962.27
| Professional | | $233.96 | $443.98 | $962.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.14 / $581.00 / $955.20
| Facility | | $265.14 | $581.00 | $955.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.77 / $395.88 / $616.86
| Professional | | $323.77 | $395.88 | $616.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.30 / $374.04 / $557.12
| Professional | | $255.30 | $374.04 | $557.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,949.18 / $5,949.18 / $5,949.18
| Facility | | $5,949.18 | $5,949.18 | $5,949.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.08 / $555.00 / $74,999.25
| Facility | | $224.08 | $555.00 | $74,999.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.05 / $426.89 / $1,058.75
| Professional | | $246.05 | $426.89 | $1,058.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,063.00 / $5,191.00 / $11,098.00
| Facility | | $2,063.00 | $5,191.00 | $11,098.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.63 / $357.89 / $776.18
| Professional | | $257.63 | $357.89 | $776.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $344.60 / $344.60 / $1,602.52
| Facility | | $344.60 | $344.60 | $1,602.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.68 / $400.71 / $733.09
| Professional | | $239.68 | $400.71 | $733.09 |